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Spatial Clustering of Suicides and Neighborhood Determinants in North Carolina, 2000 to 2017

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Abstract

Few studies in the Southeastern U.S. have examined county-level spatial patterning in suicide clusters, and no studies have examined clustering at the census block group. The objective of this retrospective ecological study is to identify high-risk suicide clusters and characterize the community-level factors associated with suicides inside and outside spatial clusters. We used the discrete Poisson SatScan statistic to identify spatial clusters in suicide for North Carolina, 2000–2017. A suicide cluster was defined as a statistically significant cluster of suicide events. Community-level determinants were obtained from the American Community Survey, and logistic regression models were used to examine the association between community-level determinants and suicide clusters. A total of 12 statistically significant high-risk spatial clusters were identified. Clusters were also identified for specific age-demographics, including adolescents (<25), the working-age population (25 to 64), and the elderly (65>). The risk ratios of suicide varied from 1.27 to 2.05 in high-risk clusters, and spatial clustering was positively associated with being male or residence in a rural area. Multivariable logistic regression found strong associations with income, population change, and educational attainment. Our results highlight the significant geographic heterogeneity in suicide across North Carolina and the need for more research that identifies localized suicide clusters for targeted public health interventions.

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Acknowledgments

We gratefully acknowledge the assistance of the NC Department of Health and Human Services (NCDHHS) for the death certificate data on suicide. We also acknowledge the support of Matt Wilson who assisted in the geocoding of suicides using residential addresses.

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Authors and Affiliations

  1. Department of Geography and Planning, Appalachian State University, P.O. Box 32066, Boone, NC, 28608, USA

    Margaret M. Sugg, Sarah Woolard & Jennifer D. Runkle

  2. North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC, 28801, USA

    Margaret Lawrimore & Jennifer D. Runkle

  3. Department of Psychology, Appalachian State University, P.O. Box 32066, Boone, NC, 28608, USA

    Kurt D. Michael

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  1. Margaret M. Sugg
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Correspondence to Margaret M. Sugg.

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Sugg, M.M., Woolard, S., Lawrimore, M. et al. Spatial Clustering of Suicides and Neighborhood Determinants in North Carolina, 2000 to 2017. Appl. Spatial Analysis 14, 395–413 (2021). https://doi.org/10.1007/s12061-020-09364-1

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